Aden Cancer Centre The Present Situation and Its Prospective [Archives:2001/35/Health]
Dr. Amin Bawazir
Assistant Prof. Epidemiology, Head, Aden Cancer Center
Faculty of Medicine & Health Sciences
University of Aden. Republic of Yemen
The starting point of the centre:
First we would like to explore that there is a profound demographic, socio-economic and behavioral transformation that have taken place n the Eastern Mediterranean Region (EMR) over the last three decades. Longevity has progressively increased and a steady shift from the traditional and rural life-style to more urbanized and modernized one are demonstrated over all these countries among which the Republic of Yemen is one of them. Due to the absence of a regional or national cancer registry, there is no reliable data about cancer that is available in most part of the Republic of Yemen. Towards the end of 1996, a workshop was held in Aden to discuss about the existing situation in the country and at the same time to prepare for the foundation of cancer centre. It was only at the beginning of 1997 that a nucleus of the first Cancer Medicine and Health Sciences was established at the University of Aden with the hope that it will be a base for all future activities in this field. It is trying to coordinate and implementation cancer related activities such as: registration of cancer cases; educational activities on cancer prevention; diagnosis; treatment; palliation and rehabilitation.
In reference to the research activities, is there any studies in this field carried out by the Centre that explore the actual problems within the community?
As the centre is at the early establishment phase, some research activity was carried out in this field by the teaching staff as well as the Center’s members such as: studying the prevalence of hepatitis B among neonates and physicians, the prevalence of cigarette smoking practice among secondary school students in Aden. The available data is on the pattern of cancer in the southeastern governorate of Yemen, pattern of breast cancer, pattern of lymphomas. The research also focus on the relation of breast cancer to the familial cancer, of thyroid cancer and others.
What is Could we the objectives and functions of the Aden Cancer Registry at your Centre?
Aden Cancer Registry is the first established cancer registry in Yemen, which started to function at the beginning of 1997, based on the following objectives:
1- To assess the magnitude and characteristics of the cancer problem.
2- To identify the general objectives and set up a measurable cancer control targets.
3- To advise on selection of an appropriate strategies for initial cancer control activities.
4- To help in establishing methods and plans for evaluating the strategies.
The Aden Cancer Registry has started to function as a hospital-based registry in early 1997 with an initial aim of assessing the available facilities that could be used for data collection and to test existing obstacles in this field. Voluntary collection of data on cancer cases and registration of the cases admitted to the hospital or reported by the pathologists or hematologists was performed initially by junior physicians at the different hospital in Aden Governorate.
At the same time, the idea for establishing a Population Based Cancer Registry (PBCR) was realized when the Cancer Registry received a grant fellowship for one of its member for a training course (on establishing Cancer Registry) on May 98 which has held in Lyon (France). This opportunity provides the mission of our cancer registry to launch a Population Based Cancer Registry. Taking into consideration the minimum requirement of this type of registries.
Does your registry cover the whole country?
The Aden Cancer Registry was based on the objective of assessing the magnitude and characteristics of the cancer problem in a defined population area. In this case it covers those cases reported from Aden Governorate and the other adjacent Governorates. It is important to note that there is a necessity to establish a series of registry in some areas such as in Sana’a, Taiz, Al-Mukalla and Hajja. As such, a National cancer Registry should be established immediately so as to compile all cases reported in the main hospitals of the country.
What is the importance of registering those cases and how does the registration functions?
The Cancer Registry is considered the corner stone for the documentation of the basic data about cancer patients and the entry into the computerized register. This is seen as an initial step for the establishment of the epidemiology of cancer. At the same time, it strives to ensure the continuity of the patient’s care.
A primary function in the operation of Cancer Registry is to bring together data from a variety of sources on the same individual. Because multiple notifications of the same tumors are likely if multiple sources of information are used, effective procedures for linking data on the same individual are very important in minimizing duplicate registration of the same tumor or individual.
According to the registered cases for the last four years (1997-2000), an annual number of cases were made available. As in the year 1997 (the 1st year of the registry) 261 cancer cases were reported (43%) were females and (57%) were male cases. Cases with Lymphomas were most commonly reported followed by Breast cancer. In the year 2000, the total cases reported were 360 cases with 56.9% were females and 43.9% were male. By excluding the sex related cancer cases, the main cancers reported were Lymphomas (17.9%) and followed by gastrointestinal system (16.0%). But breast cancer among the females was the highest one with about (38.1%).
Limitations and constrains
It is clear that our registry like any other newly established registry, would face some teething problems. This study was our first experience to analyze the situation of our Cancer Registry. Some of these could be observed on:
The limitation of data according to sites, and this will led to limit the interpretation of the data or even may not give appropriate justification for comparison with other countries.
The percentage of coverage for the year 1997 was estimated to be within the range of 75% -80% of the total population. This limitation was in principal due to the difficulties appeared at the beginning to cover all the health institutions and other private hospitals. In additional to that, there was no clerk employed at that moment to collect all the necessary data. The absence of experience by the medical team and health workers at the hospital and health care institutions to this process of collecting such data on cancer cases along with the loss of cooperation hampered our effort.
The Yemeni Association for Cancer Detection, was not established then to enable proper reporting and follow up on the cancer cases. The absence of critical yet thorough information, e.g. the extension of the tumor, the accurate site, the state of the patients (some patients were travelling abroad for their treatment after they were diagnosed). Death Certificates were poorly included as a source of data due the poor system of registering dead cases in the country.
The main prospective of the registry:
For that reason, the main prospective of the registry will be dedicated towards the application of some activities, in which it will concentrate on the following:
-To carry on an annual seminar jointly with the Faculty of Medicine and Health Sciences, the Ministry of Health and specialists at the corresponding fields in order to discuss with them the obtained analysis and the mechanism to overcome those constrains, (Feedback).
-To motive those who are interested in research on cancer by using the available data in the registry.
Of great importance is the constant support needed by the registry from internal institutions as well as foreign organizations. This will ensure the continuity of the established function of the Registry on cancer cases in Aden. With that as the first step, we will then extent our coverage to the more adjacent governorates.
We need to motivate those who are concerned on cancer problems, particularly on the study of the most preventable factors that should be observed by our local communities. It should be launched as applied researches.
Implementation of guidelines for the management of the symptoms in breast cancer at primary care centers and application of prevention program at this level for the most preventable cancers.